Rowe, Richard Form VS.$1. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Vilage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No—........._................._
Village Rome
Dist. No County Oneida or City
(If city,give street address)
Name of deceased Richard Rowe Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex....Male Color Whjtg....or divorced (wnte the word) Single Date of Death 3'-! 19 i,3
Age 3.9 Years 4 M nths 17 -,.....Days BirthplaceGlenSFa s, New York
Cause of Death Cam....
Certificate was signed by ....... { f%�� t? M.D.
Address X e1j-c..... o -4rr.`: / c'�'t W
Place of Burial (or Removal) G1en,,Falls, New York
(If body is to be temporarily held,fill in space later)
Cemetery tA...AL.phPX1PR Date of Burial June 25 , 1963
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFAC!'ORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to martin J, Munn Rome, New York
Funeral Direc`LOY' Inter (Address)
the tl to hold temporarily and the body.
(Undertaker or person having charge of corpse) (Ine ,remove, othe is o of tat bow])
Dated sl.uAe..2.2, 19.5. (Signed). ^� . .�
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date ofQfrk-ja,Th
was Z`r 19 G�
(Interment or Cre ion)
tory, Cretoriurn, e .)
P tk) il\-5'T—d0 ,
' --Section Lo No. Grave No.
Q 6i?..„...e(Si�ed)V2 .
(Person in char ) SS
(4, )
Address ll/ O i
)1 j(
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above date. If no person is in charge, the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the words
"No person in charge," and FILE PERMIT WITHIN THREE
(3) DAYS with the Registrar of District in which
cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.